Building an Injury Surveillance System: Cameroon National Trauma Registry A collaboration with the Ministry of Public Health in Cameroon to develop and expand a National Trauma Registry (NTR) with the aim of providing ongoing injury surveillance and to demonstrate the burden of trauma on the health system in Cameroon. Findings from this prospective, observational trauma registry will inform national injury prevention policy and will set the foundation for establishing hospital-based trauma care quality improvement programs. Currently, the NTR has launched in four hospital sites (Hopital Laquintinie de Douala, Hopital Regionale de Limbe, L'Hopital Catholique de Pouma and Hopital Regional d'Edea) where data are collected on admitted trauma patients.
A Mobile Phone-based Triage Tool to Identify Discharged Trauma Patients in Need of Further Care in Cameroon An NIH funded R21 project nested in the Cameroon National Trauma Registry. The overall objective of the project is to improve timely medical follow-up for injured patients in Cameroon to reduce the impact of injury. As injuries become an increasingly important public health priority in low- and middle-income settings, including sub-Saharan Africa (SSA), context-appropriate methods for improving trauma care are lacking. While over 60% of injured patients in Cameroon seek formal care, there is no mechanism to follow these patients for further care after they are discharged from the hospital. The growing network of mobile phones in Cameroon presents a novel opportunity to reach populations that have been previously lost to follow up. The study seeks to 1) establish the feasibility of mobile phones as a follow-up tool for hospitalized trauma patients after discharge in Cameroon; 2) cross-validate a mobile phone-based assessment tool to identify trauma patients who would benefit from further medical care; and 3) characterize the impact of timely follow-up on long-term disability and socioeconomic consequences associated with trauma in Cameroon.
Building Capacity for Trauma Quality Improvement: An Innovative Pilot Program in Cameroon to Address the Burden of Injury An NIH funded R21 project utilizing data from the Cameroon National Trauma Registry. The overall objective of the project is to build on an existing centralized trauma registry by developing culturally relevant, peer-driven comprehensive trauma QI process appropriate for the Cameroonian context and generalizable to other similar SSA settings. The study will 1) establish and train a peer-driven trauma care QI committee in Cameroon that can perform comprehensive case review and root cause analysis to identify specific correctable deficiencies; 2) Train research personnel to develop research and analytic skills in QI methodology, monitoring, and evaluation; 3) Apply the QI process to refine the existing trauma registry data collection tool, enhancing its capacity to capture changes in the quality of clinical care delivery; and 4) Implement QI committee meetings to propose context-appropriate trauma QI interventions for future implementation in Cameroon and similar settings.
Injury and Care-Seeking Behavior in Southwest Cameroon: A Community-Based Survey This community-based study was carried out to estimate the yearly incidence of injury in the Southwest region of Cameroon, with an emphasis on understanding patterns of injury and care-seeking behavior among households with injured persons who do not present to formal care. The study explored the determinants of therapeutic itinerary including barriers and facilitators of care. Furthermore, the study also carried out economic analyses to estimate household loss due to long-term disability. Data collection has been completed and dissemination of findings is ongoing through publication in peer reviewed journals.
National Surgical Plans Initiative to develop country-specific surgical plans in partnership with national authorities, NGOs, and major donors with the aims of: gathering data on current surgical capacity; increasing resources for surgical services; providing sustainable models that can help guide policy makers in developing countries; and, ultimately elevating the status of surgery on the global public health agenda.
Economic Clusters Modeling Dr. Lauren Eyler, a physician at UCSF, is interested in developing novel machine learning algorithms to help build surgical systems and improve health equity in low- and middle-income countries (LMICs). She previously collaborated with Dr. Julliard to write a k-medoids clustering based algorithm to define simple, population-specific metrics of economic status for LMICs based on Demographic and Health Surveys (DHS) data. These EconomicClusters models may be used for health disparities research in settings where traditional metrics, which are based on lengthy questionnaires, are not feasible to assess. She developed an R package available on Github and an R Shiny app so that other researchers may develop EconomicClusters models for any country with DHS data. She is currently working on a statistical algorithm to define population-targeted breast cancer risk prediction models for ethnic groups with limited data.
Trauma Surveillance at Soroti Regional Referral Hospital, (SRRH) A prospective trauma registry collecting information on patients presenting with traumatic injury at SRRH. The registry is designed to serve as a trauma surveillance database to aid evaluation of trauma care at SRRH. The trauma registry is a prospective, observational study using hospital-based data sources. The study aims to improve the quality of essential and emergency surgical care at Soroti Regional Referral Hospital in Uganda.
Non-Trauma Surveillance at Soroti Regional Referral Hospital, (SRRH) A prospective registry collecting information on obstetrics and gynecology patients and patients presenting for general surgical care at SRRH. The study aims to inform surgical care treatment priorities in SRRH for potential intervention. The non-trauma registry is designed to serve as a surgical surveillance database to aid evaluation of general surgical and obstetric/gynecologic care at SRRH.
In-hospital length of stay and the economic impact associated with surgical conditions at SRRH This study is aimed at prospectively gathering baseline data and identifying the factors that affect the in-hospital Length of Stay (LoS), resource utilization, and costs associated with surgical conditions encountered at Soroti Regional Hospital. Follow-up of patients is also conducted by phone at 3 weeks, 3 months and 6 months to gather data on patient reported outcomes. There is an opportunity cost associated with excess LoS. In addition to identifying high-impact interventions that will optimize patient flow, LoS, and the quality of care at SRRH, this study seeks to generate evidence required to make a case for investing in the provision of specific surgical procedures.
Cost-Effectiveness of Exploratory Laparotomy in SRRH, Uganda Globally, cost-effectiveness data are lacking for a wide range of essential surgical procedures. This study addresses this gap by defining the cost-effectiveness of exploratory laparotomies in a regional referral hospital in Uganda. A prospective observational economic analysis study was designed to determine the cost-effectiveness of exploratory laparotomies conducted at SRRH. The study determined the incremental cost-effectiveness ratio of exploratory laparotomies compared with the status quo in the Soroti region, which is alternative medical management with likely poor and probably fatal outcomes.
Establishing National Cancer Screening Programs in Armenia Despite significantly high rates of lung, colon, breast, head and neck, and cervical cancers, no organized screening programs currently exist in the Southern Caucasus nation of Armenia.This project aims to study the feasibility of implementing organized national cancer screening programs int eh country. Active areas of research include: 1) the assessment of capacity and quality of such such services in both urban and rural areas of the country; 2) the assessment of knowledge, attitude, perceptions and barriers to adherence of screening modalities; 3) the development of contextually appropriate screening guidelines.
Developing a Fetal Care Program in Armenia The state of fetal care in Armenia is fragmented and in its infancy. Under the auspices of the Ministry of Health, a task force has been developed to coordinate and improve fetal care. As no data on practices, outcomes and attitudes towards fetal care exist, this project seeks to conduct further research to analyze the current situation and advise on necessary next steps.
UCLA-Mozambique surgical partnership
The UCLA-Mozambique surgical partnership founded in 2010 and led by Dr. Daniel DeUgarte aims to facilitate training of Mozambican pediatric surgeons and anesthesiologists and to promote local research and quality improvement projects. The partnership supports these aims by disseminating educational materials, proctoring surgeons, sponsoring courses, coordinating bilateral exchanges, promoting regional board certification, and providing opportunities to establish dedicated pediatric operating room facilities to support training.